JACC: Heart Failure ( IF 10.3 ) Pub Date : 2022-04-06 , DOI: 10.1016/j.jchf.2022.01.010 Kangyu Chen 1 , Chao Li 2 , Victoria Cornelius 3 , Dahai Yu 4 , Qi Wang 1 , Rui Shi 5 , Zhenqiang Wu 6 , Hao Su 1 , Ji Yan 1 , Tao Chen 7 , Zhixin Jiang 8
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Background
Blood pressure (BP) is a continuous and dynamic measure. However, standard BP control metrics may not reflect the variability in BP over time.
Objectives
This study assessed the prognostic value of time in BP target range among hypertensive patients with heart failure (HF).
Methods
The authors performed a post hoc analysis of data from the TOPCAT (Treatment of Preserved Cardiac Function HF with an Aldosterone Antagonist) trial and the BEST (Beta-Blocker Evaluation of Survival Trial). Time in target range (TTR) for each patient was calculated using linear interpolation across the study period with the target range of systolic BP between 120 and 130 mm Hg.
Results
A total of 4,789 hypertensive patients (n = 1,654 from BEST and n = 3,135 from TOPCAT) were included. The cumulative incidences of primary endpoint (ie, cardiovascular death or HF hospitalization) were highest among the top quartile of TTR with a dose-dependent manner across quartiles (Ptrend <0.005). The top quartile of TTR was significantly associated with a lower risk of primary outcome using adjusted Cox regression model (HR: 0.71; 95% CI: 0.60-0.82), cardiovascular mortality (HR: 0.68; 95% CI: 0.55-0.84), HF hospitalization (HR: 0.70; 95% CI: 0.58-0.85), all-cause mortality (HR: 0.69; 95% CI: 0.58-0.83), and any hospitalization (HR: 0.76; 95% CI: 0.67-0.85). Further analyses using restricted cubic spline indicated a linear relationship between TTR and primary outcome. Similar patterns were observed in the individual trial. Sensitivity analyses generated consistent results while redefining target range as 110 to 130 mm Hg for systolic BP or 70 to 80 mm Hg for diastolic BP.
Conclusions
TTR could independently predict major adverse cardiovascular events in hypertensive patients with HF.
中文翻译：
心力衰竭患者血压目标范围内时间的预后价值
背景
血压 (BP) 是一种连续和动态的测量方法。然而，标准的血压控制指标可能无法反映血压随时间的变化。
目标
本研究评估了高血压合并心力衰竭 (HF) 患者血压目标范围内时间的预后价值。
方法
作者对 TOPCAT（用醛固酮拮抗剂治疗保留的心脏功能 HF）试验和 BEST（生存试验的 β 受体阻滞剂评估）的数据进行了事后分析。每位患者在目标范围内的时间 (TTR) 是使用整个研究期间的线性插值计算的，收缩压的目标范围在 120 和 130 mm Hg 之间。
结果
共纳入 4,789 名高血压患者（来自 BEST 的 n = 1,654 和来自 TOPCAT 的 n = 3,135）。主要终点（即心血管死亡或心衰住院）的累积发生率在 TTR 的前四分位数中最高，并且在四分位数之间呈剂量依赖性（P趋势 <0.005)。使用调整后的 Cox 回归模型 (HR: 0.71; 95% CI: 0.60-0.82)、心血管死亡率 (HR: 0.68; 95% CI: 0.55-0.84)、 HF 住院（HR：0.70；95% CI：0.58-0.85）、全因死亡率（HR：0.69；95% CI：0.58-0.83）和任何住院（HR：0.76；95% CI：0.67-0.85） . 使用限制三次样条的进一步分析表明 TTR 和主要结果之间存在线性关系。在个别试验中观察到类似的模式。敏感性分析产生了一致的结果，同时将目标范围重新定义为收缩压 110 至 130 mm Hg 或舒张压 70 至 80 mm Hg。
结论
TTR 可以独立预测高血压合并 HF 患者的主要不良心血管事件。
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